Tuesday, July 14, 2015

Evidence-based Benefits of Attending Childbirth Education Classes: 7 Validating Studies

Pregnancy brings a myriad of questions.  These questions include:

“Should I attend childbirth classes?”
“I have limited time – is there an express class I can take?”
“Perhaps I can take a class online.”
“My doctor said I don’t really need to attend since I am getting my epidural.”
“Childbirth classes are not covered by insurance.”

Researching is emerging again about the benefits of antenatal/childbirth education classes.  Previously, expectant parents attended classes as part of a traditional routine of all expectant parents to gain familiarity with the process.  In the 1980s, when a large majority of childbirth education classes moved into the hospital setting, attendance at classes served as an introduction to the hospital policies and procedures.  However, today the research is showing definite physical and emotional benefits of childbirth education classes.

 1. Physical exercise and perceived stress/depressive symptoms lessened  in postpartum with physical activity facilitated through childbirth education classes.

A 2014 study from Poland demonstrated the benefits of physical activity promoted by childbirth education classes. Declared physical activity during pregnancy was linked to lower levels of stress experienced by women and less severe depressive symptoms after childbirth, especially in the group of childbirth classes participants. In this study, 100 women completed the Edinburgh Postnatal Depression Scale.


Kowalska, J. et al (2014) Physical activity and childbirth classes during pregnancy and the level of perceived stress and depressive sympptoms in women after childbirth. Psychiatrica Polska Sept oct 48(5) 889-900.

2.    Of those who attend childbirth education classes, there was a higher patient satisfaction with birth experience and self as emerging new parent.  Classes significantly influenced the psychological well-being of the pregnant women.
Jakubiec, D. et al. (2014) Effect of attending childbirth education classes on psychological distress in pregnant women measured by means of the General Health Questionnaire. Advances in Clinical and Experimental Medicine: Wroclaw Medical University. Nov-Dec 23(6): 953-7
Bahrami, N. et al.(2013) The effect of prenatal education on Mother’s quality of life during first year postpartum among Iranian Women: A RCT International Journal of Fertility and Sterility. Oct 7(3): 169-74.

3.    Attending childbirth education classes and learning about breastfeeding has a positive influence on breastfeeding during the first month.
Initially, 90% of women breastfed their infants, with no differences between the groups. During the first month, the risk of cessation of any breastfeeding was three times as high among non-attendees and twice as high among women who attended 1-4 classes compared with those who attended 5 or more classes. The risk was, however, similar in the three groups from the end of first month onwards.
Artieta-Pinedo, I. et al (2013) Antenatal Education and Breastfeeding in Cohort of Primiparas.  Journal of Advanced Nursing July 69(7) 1607-17

4.    In childbirth education class, attendees learn about the impact of fluids and food (or the restriction thereof) on the labor process.
“The concern with oral intake in labor is that it risks death from aspiration should general anesthesia be required. We quantified that risk using cesarean data from U.S. studies. The primary (first) cesarean rate in 2006, the latest year for which we had this statistic, was 24%, of which all but a few percent would have been during labor. In the Netherlands, where women are freely permitted oral intake, the mortality rate from aspiration during cesarean surgery is 0.9 per 100,000. Using 24% as a proxy rate for intrapartum cesareans, multiplying it by the percentage of cesareans done under general anesthesia in the U.S. (15%), and multiplying that result by 0.9 per 100,000, the likelihood that a fed woman having an intrapartum cesarean under general anesthesia will die of pulmonary aspiration is 3.2 per 10 million. To put this number into perspective, in 2003 she would have been twice as likely to die of aspiration during cesarean surgery than to be killed by a lightning strike (1.6 per 10 million), but she would have been 8 times more likely to die in a plane crash (26 per 10 million) and nearly 200 times more likely (543 per 10 million) to die in a car crash. She would also be nearly 900 times more likely to die of an elective repeat cesarean (2800 per 10 million).”
Goer H., and Romano A. (2012) Optimal Care in Childbirth: The Case for a Physiologic Approach. Classic Day Publishing.  Passage from chapter 11, Routine IVs Versus Oral Intake in Labor: “Water, Water Everywhere, Nor Any Drop to Drink”. 

5.    Wisely participate in the decision making process, especially with interventions such as labor induction
Study results suggest attendance at prepared childbirth classes can be an effective source of information regarding elective labor induction and influential in women's decisions regarding whether or not to have elective labor induction. Women perceive prepared childbirth classes positively and find the information provided valuable.
Simpson, K. et al (2010) Patients’ perspectives on the role of prepared childbirth education in decision making regarding elective labor induction. Journal of Perinatal Education. 19(3) 21-32

6. The Internet is widely used as a source of information amongst participants of antenatal classes, both male and female.
Approximately 95% have used it at some point to find information during pregnancy, but the majority (approximately 90%) had no knowledge of websites run by not-for-profit organisations and preferred commercial websites. Relevance to clinical practice.  Instead of disregarding the use of the Internet as a source of information during pregnancy, midwives should keep up to date and give their patients links to high-quality sites.
Lima-Perieira, P. et al. (2012)Use of the Internet as a source for health information amongst particpationts of antenatal class.  Journal of Clinical Nursing Feb: 21 (3-4).

 7. Antenatal classes or childbirth education classes should not be limited to short classes or one solely focused class.
At the time of this research, consideration was being given to designing a comprehensive birth and parenting program that straddled the birth experience—that is, the program would provide five or six prenatal and two or three postnatal sessions. This structure proved to be difficult to implement for logistical and financial reasons, so it did not proceed. The results of this research demonstrate that further work is required with this concept.  Finally, findings from this study add to the increasing amount of research reporting on educative strategies that meet men's needs during the childbearing year. Men should no longer be seen as adjuncts but as an integral part of the childbearing experience. Their needs require consideration.
Svensson, J. et al. (2008) Effective Antenatal Education: Strategies Recommended by Expectant and New Parents.  Journal of Perinatal Education. Fall 17(4): 33-42.

No comments: